Mark Trahant: The Indian Health Service and state budget shortage

"Last week Secretary of Health and Human Services Secretary Kathleen Sebelius wrote a letter to governors that said her agency will help “identify cost drivers in the Medicaid program and provide you with new tools and resources to achieve both short-term savings and longer-term sustainability while providing high-quality care to the citizens of your states.”

One of those drivers -- and potential savings for states -- ought to be the Indian health system. First, remember that Medicaid (and a Children’s Health Insurance Program) is an entitlement, and not an appropriation. That means the money is there for any eligible person. This is money that can expand services for every patient in the Indian health system. Second, and critical for states, the federal government gives a 100 percent match for clients in the Indian health system. It ought to be in states’ interest to enroll as many American Indians and Alaska Natives and spend as much as possible on reimbursable care.

But states have an illogical role in this system. Even the states that embrace this role have to navigate an extraordinarily complicated maze of rules and regulations. What happens, for example, when a young person moves from a reservation community to Haskell or another school? A study by Spokane’s Kauffman and Associates found that to be a logistical “nightmare.” The young people should have remained eligible but were rejected because they were not considered a resident of the state where the school was located. There are many, many more complications in the complicated dance between Medicaid, state governments, tribes and the Indian health system."

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